KIMBERLY MODENA TATUM (NPI# 1518479542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518479542 |
| Entity Type | Individual |
| Full Name | KIMBERLY MODENA TATUM |
| Credential | NURSE PRACTITIONER |
| Practice Address |
3201 University Dr E Ste 135 Bryan TX 77802-3481 |
| Mailing Address |
973 Stone Lake Dr Ormond Beach FL 32174-1487 |
| Practice Telephone | 9797031832 |
| Practice Fax Number | 9797031937 |
| Mailing Telephone | 9316289210 |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2020-01-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 9471546 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP136159 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225258494 | Kimberly Gardner Tatum | Physical Therapist | 104 Silver Point Lane, Hattiesburg, MS 39402 | 2007-04-27 |
| 1366704488 | Kimberly Anne Tatum | Nurse Practitioner | 1300 Baxter St, Suite #170, Charlotte, NC 28204-3053 | 2012-06-14 |
| Street Address |
3201 UNIVERSITY DR E STE 135 |
| City | BRYAN |
| State | TX |
| Zip Code | 77802-3481 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952627242 | Cody Van Emery | Physician Assistant | 3201 University Dr E Ste 135, Bryan, TX 77802-3481 | 2010-04-13 |
| 1275060360 | Lauren Alexandra Mckay | Physician Assistant | 3201 University Dr E Ste 135, Bryan, TX 77802-3481 | 2017-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013476951 | Andrea Pittman | Student in an Organized Health Care Education/Training Program | Primary Care Medicine Department, College of Medicine, 2900 East 29th Street, Bryan, TX 77802 | 2019-03-19 |
| 1942789110 | Alicia Diane Ates | Dentist | 3001 Wildflower Drive, Suite #511, Bryan, TX 77802 | 2018-08-09 |
| 1588151682 | Metx LLC | Audiologist-Hearing Aid Fitter | 3030 E 29th St Ste 102, Bryan, TX 77802 | 2018-04-16 |
| 1073047437 | Abbi Messer | Family Medicine | 2900 29th Street, Suite 100, Bryan, TX 77802 | 2017-04-12 |
| 1265885180 | Scott Andrew Thayer | Dentist | 3811 Stoneparc Dr, Bryan, TX 77802 | 2016-07-15 |
| 1255792123 | Phoebe Mathew | Pharmacist | 3312 East 29th Street, Bryan, TX 77802 | 2016-03-18 |
| 1801253810 | Pearl Coleshill | Specialist/Technologist | 3121 University Drive E., Suite 100, Bryan, TX 77802 | 2016-01-21 |
| 1265847750 | Wesley Danielle Daniels | Dietitian, Registered | 3900-c Carter Creek Pkway, Bryan, TX 77802 | 2014-06-24 |
| 1235549098 | Regina V. Robertson | Home Health | 1121 Briarcrest Dr., Suite 102, Bryan, TX 77802 | 2014-05-02 |
| 1982024238 | Lampstand Nursing and Rehabilitation, Lp | Skilled Nursing Facility | 2001 E 29th Street, Bryan, TX 77802 | 2014-04-24 |
| Find all providers in zip 77802 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194291898 | Jaime Hardy | Nurse Practitioner | 5873 Easterling Dr, Bryan, TX 77808-7830 | 2018-10-19 |
| 1659859106 | Shameka Crump | Nurse Practitioner | 3201 University Dr E Ste 280, Bryan, TX 77802-3490 | 2018-08-06 |
| 1063931715 | Laura Lea Pugh | Nurse Practitioner | 2700 E 29th St Ste 235, Bryan, TX 77802-2586 | 2017-09-13 |
| 1184147068 | Danyel Renae Parker | Nurse Practitioner | 201 E High St Ste 2, Bryan, OH 43506-1773 | 2017-07-21 |
| 1154872687 | Rosantina Broom | Nurse Practitioner | 3370 S Texas Ave Ste B, Bryan, TX 77802-3127 | 2016-10-19 |
| 1831648690 | Teresa Dejesus Ramirez | Nurse Practitioner | 1307 Hazel St, Bryan, TX 77803-3633 | 2016-09-22 |
| 1265701841 | Jennifer M Meaders | Nurse Practitioner | 1716 Briarcrest Dr Ste 300, Bryan, TX 77802-2777 | 2011-12-28 |
| 1821377300 | Wendy J Seneff | Nurse Practitioner | 2700 E 29th St Ste 325, Bryan, TX 77802-2588 | 2011-08-15 |
| 1497809719 | Mary Ellen Pate | Nurse Practitioner | 3370 S Texas Ave., Suite G, Bryan, TX 77802-3127 | 2007-01-23 |
| 1568423259 | James Timothy Gray | Nurse Practitioner | 3841 Sagebriar, Bryan, TX 77802-6107 | 2006-03-31 |
| Find all providers in BRYAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.